Important Information on Changes to SmartHealth Coverage
SmartHealth helps support you during the COVID-19 pandemic
You and your family can fight COVID-19 by getting vaccinated and following the advice of your doctor, providers, and the CDC. SmartHealth covers the cost of the FDA-approved vaccine at no cost to members.
COVID-19 vaccines are safe and effective at preventing COVID-19. Getting vaccinated will help end the pandemic and help keep our communities healthy.
Regardless of insurance status, each U.S. household is eligible to order four free tests. Click here to learn more. SmartHealth also covers 100% of the cost for up to eight FDA approved test kits within 30 days, obtained through:
- Ascension Rx retail locations
- Cigna retail pharmacy network locations (including Walgreens, Walmart, CVS, etc.)
Click here for more information.
Follow all healthcare providers’ advice, and CDC guidelines on COVID treatment and testing.
Changes to SmartHealth coverage
As part of Ascension’s continued efforts to meet the health and wellness needs of our associates and covered dependents, we are enhancing SmartHealth medical plan coverage for care related to the diagnosis and treatment of COVID-19.
Effective March 15, 2020 through October 13, 2022, we are waiving deductibles, copays and member cost-sharing for provider office visits, urgent care visits, emergency department visits and virtual urgent care visits through Ascension Online Care related to COVID-19 diagnosis, and COVID-19 testing and care for all members enrolled in either the SmartHealth PPO Plan or the SmartHealth High Deductible Health Plan (HDHP).
What to know when deciding where to get care:
- Ascension Online Care and your Primary Care Provider (PCP) can help guide you as to where to receive care and what next steps you should take regarding any symptoms that you may be experiencing.
- Use emergency department resources as recommended by your health care provider.
- Not everyone is a candidate for getting the COVID-19 test. Your doctor will decide, based on your symptoms, whether you should receive the test.
- For information about coronavirus including what we know, symptoms and prevention please click here to download more information.
The following medical plan coverage enhancements will apply during this period:
- Virtual urgent care visits provided by Ascension Online Care are covered with $0 cost to SmartHealth members. We highly recommend using online care as a way of avoiding exposure to germs. COVID-19 test orders are not available through Ascension Online Care.
- Physician’s office, clinic or urgent care visits related to COVID-19 provided at a will be covered at 100%, without member cost-sharing at Ascension Network, National Network and out-of-network providers.
- Emergency department visits that result in an order for or administration of a COVID-19 test will be covered with no member cost-sharing at Ascension Network, National Network and out-of-network providers. All other emergency department visits will be covered under the present Schedules of Benefits.
- Laboratory charges directly related to COVID-19 testing will be covered with no member cost-sharing, regardless of whether the testing occurs at a physician’s office, clinic, urgent care, emergency department or another laboratory.
- Inpatient treatment an Ascension Network (Tier 1) location will be covered at 100%, without deductibles, coinsurance or copays. To find which locations are in the Ascension Network please use the location search on mysmarthealth.org.
- Inpatient treatment at a National Network (Tier 2) or Out-of-Network (Tier 3) location will be covered at the Ascension Network (Tier 1) member cost-sharing (deductibles, coinsurance and copays).
- There are no prior authorization requirements for members to receive COVID-19 testing or for COVID-19 or suspected COVID-19 inpatient admissions. For more information about prior authorization, please visit the Information Center.
- Be advised that you may experience balance billing or reduced continuity of care if you go to an Out-of-Network provider. If you receive care at an Out-of-Network (Tier 3) provider, you may receive a bill from the provider requesting additional payment above the SmartHealth maximum payable charge. This is known as a balance bill. If you receive a balance bill, please contact customer service.
Are there other coverage changes at this time?
- Charges associated with treatment, hospitalization or other care will continue to be covered according to the member’s SmartHealth schedule of benefits. Members with questions about their coverage and benefits should refer to their schedule of benefits or call SmartHealth customer service for details.
To view the Summary of Material Modifications associated with this change in coverage please click here.
For questions about SmartHealth coverage, benefits and claims please contact customer service at (888) 492-6811.
For COVID-19 related questions on coverage, billing, prior authorization and more, please view our FAQ here.
For questions on virtual visits and billing, please review our virtual billing guide here.
Applicable diagnosis codes related to COVID-19 can be found here. (Updated 2/3/21)
Recommended codes for virtual services can be found here. (Updated 2/5/21)